Thursday, June 20, 2013

A Safe Place

Sometimes
something happens at work and the experience perseverates in your
mind. Often it is the experience of having to be the bearer of bad
news to one of your patients. Fortunately, on occasion a patient comes
back for the sole purpose of telling you how well they are doing and to
thank you. Those experiences stick for a while too. Sometimes I wish
people with positive outcomes were the ones who came back to see us on a
regular basis. But alas, that is not the nature of health care.

Well,
something happened earlier this week that was outside the scope of the
usual experiences at the clinic. For some reason, this event is stuck
in my head and I am compelled to write about it. I feel the need to
share it with others because, well, I have never experienced this before
and the event touched me deeply.

I was in my office
dictating the note for the patient I had just seen and I thought I heard
what sounded like a quiet sobbing from someone from the lobby area,
where patients enter and leave for treatments like massage and
acupuncture. I think I wondered about what it was I was actually
hearing, wondered if it was really the sound of sobbing, probably
confirmed in my head that's what it was, and probably presumed that a
person there to see one of the other providers was having a bad day.
Nothing sounded urgent, and I continued with my paperwork and prep for
my next patient.

I went to receive my patient in the lobby
and as we walked passed the one of the cubicles, I saw the source of
the sobs, which continued steadily from a woman who was collapsed in a
chair, her head resting on the table in her arms, as her body heaved in
muffled distress. Two of the therapists seemed to be sharing the act of
providing physical comfort and words of comfort, though every gentle
touch seemed to open the heart's flood gates, making the sobs louder and
a bit more alerting for the moment.

I made eye contact
with the therapist as she held her hand on the despondent woman's
shoulder. The therapist gave me a sad but reassuring grin that
everything was ok.

I treated my patient and we exited to the checkout desk in a route that provided the most privacy to anyone still around.

On
my way back to my office, I heard the continued sounds of sobbing, sobs
that now seemed to need some self-encouragement to continue, with less
pressure behind the breaths. Maybe it was the completely clogged
sinuses that prevented her from gaining enough oxygen to produce much
noise. But the waning sobs were still leaking from her body.

This
time, as I passed the woman whose forehead was still pressed tightly
into her folded arms across the cubicle desk, I stopped to try to
recognize her. She was in one of the massage therapist's cubicles, but
it clearly wasn't the massage therapist herself. The other therapists
were still checking in and providing quick physical and mental
reassurance as they, themselves, flitted between their own scheduled
patients. I moved a little closer and said, "Is there anything I can
do?" The woman looked up. It was the first time I saw her face and,
despite the swollen eyes and tear-drenched face, I instantly recognized
her as one of my previous patients who must have been there still doing
some periodic massage or acupuncture at the clinic.

"Oh,
Dr. Bliss!" she said. "I hurt. My big dog knocked me down and I hurt
here and here and here," and she pointed all over her body, each time
with increasing build-up for another waterfall of tears. Her breathing
grew rapid, and her face furrowed deeply and she said, "I have so much
going on...." and she put her head down and sobbed with new vigor.

What could I do?

She
was physically ok despite her complaint of pain. She was obviously in
quite severe emotional pain. That was obvious. It was also crystal
clear that she was in the right place to treat her emotional pain. It
was clear that the cause of her pain was not what mattered at that
moment. At that moment what mattered was that she was in pain and she
had a safe place to go with that pain.

I put my hand
gently on her shoulder and I told her it would be good for her to just
let it all out here. She could stay as long as she needed. It might be
just what she needed before leaving that safe cubicle place and
venturing back into the wilderness of whatever it was that she was
having to deal with in her world.

One of the
gentle-speaking therapists came over and we both walked away together.
"I think she just needs to let it out, right?" she said. "I think this
is a safe place for her to do that."

Yes, I said.
Exactly. That's exactly what this is, a safe place. She could stay and
cry for as long as she needed. She didn't need to "cheer up" or to
"count her blessings" or "take some medication." No, she just needed to
be. It was ok. It was just sadness; it was just despair. We were
cautious but we were not afraid. Who is afraid of it? Why be afraid of
it? She was in the perfect place for her and her despair. This was
our healthcare facility where we care and where we help people the best
we can. Sometimes the best thing to do is to do nothing and just provide
safety.

It was just what she needed, a safe place. The
therapists who let her be and checked up on her, keeping everything calm
and accepting and safe, provided such kindness... so much kindness that
I cannot get the event out of my mind.

The woman
eventually ran out of tears, wiped her face and, when she was ready, she
left. She appeared numb but she did after all, lift her own head up,
stand up on her own power, and walk out the door when she was ready...
to face who knows what. She clearly left some of her feelings of
helplessness, despair, frustration... and who knows what... on that desk
top. She was now clearly a little stronger.

I am proud
of the therapists. The word proud is perhaps not the best word, but my
heart swells when I think of the event. Kindness. Gentleness.
Acceptance. Humility. These are the qualities that come to my mind.

A
safe place. A healthcare clinic where the lines between emotional pain
and physical illness are blurred, more than we may realize. Healthcare
clinics should be safe places. Ours is. To the therapists who cared
for this woman who once was a patient of mine, thank you. You are a
blessing.

About Me

I am an ultra runner, physician and have been medical director of some of the toughest ultras. I tend to be a mover and a shaker and louder than my size suggests. However, my Gemini twin is gentler and contemplative, an artist, a writer, and a poet. I am a dog lover, a believer in souls, and have a special affinity for those who struggle because I have been there.

This is my crazy lovable huggable Weimaraner, Steely Dan. I call him Steely. He left us in January of this year at only 6 years from lymphoma that did not respond to chemotherapy treatments. Steely was a total goof. He loved trail running, road running, treadmill running, new experiences, making eye contact, sleeping on his back, me, kids, and liver treats. He was Zappa's best friend. We miss him dearly.

This is Stella. A rescue from the shelter. She's about 6 months old and a Border Collie. She is a joyous bundle of energy and curiosity and now also Zappa best friend. She will make a nice running partner when she grows up.

This is the now the big brother of my family - a rescued Greyhound. His name is Frank Zappa. I call him Zappa. He's 7 years old and has learned all about life beyond the track and crate from Steely when he was with us. It was very rewarding to watch his personality bloom as he settled into the family. And yes, he runs like the wind!

This is Natasha, my dearest friend. She was with me through college, medical school, residency, and she moved with me from Chicago to Spokane several years ago. She was my best running partner for 10 years. My sweet Natasha died from bone cancer in 2006. I miss her still. I hung a windchimes over the deck outside. When it chimes, I smile and think she has finally -- wherever she is now -- caught a squirrel!